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Long-term curative effects of combined hepatocholangioplasty with choledochostomy through an isolated jejunum passage on hepatolithiasis complicated by stricture

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Hepatobiliary & Pancreatic Diseases International 2005年第1期4卷 64-67页

作者： Yong Li Jun Cai AnTao Wu ZiJian Wang Department of General Surgery First Affiliated Hospital of Jiangxi Medical College Nanchang 330006 China. jiangyipuyai@***

BACKGROUND:Hepatocholangioplasty combined with choledochostomy was designed through an isolated jejunum passage in 1988. This study was undertaken to evaluate its long-term curative effects in 163 patients.;METHODS:The 163 patients with hepatolithiasis complicated by stricture were treated with this procedure from 1988 to 2003.;RESULTS:Among these patients, 19 patients with postoperative hepatolithiasis complicated by acute cholangitis were treated successfully with percutaneous paracentesis drainage through the isolated jejunum passage and without operation, 36 patients had postoperative residual or recurrent stones (35 patients had stones removed through the stoma and one underwent relaparotomy because of stenosis of the common bile duct along with stone in canceration). The clearance rate of stones after the isolated jejunum passage was 97%; 35 patients (21%) complicated with stricture due to hepatolith were treated with combined hepatocholangioplasty and choledochostomy. Follow-up for 1 to 15 years showed no recurrent stricture of the biliary tract. The operation also successfully prevented reflux cholangitis and other serious complications after Roux-en-Y cholangio-jejunostomy.;CONCLUSIONS:Hepatocholangioplasty combined with choledochostomy through an isolated jejunum passage may significantly improve the long-term curative effects of hepatolithiasis with stricture.

关键词： cholelithiasis hepatocholangioplasty choledochostomy

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An Unusual Life-Threatening Hemobilia Caused by Hepatic Pseudoaneurysm Following choledochostomy: A Case Report

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Case Reports in Clinical Medicine 2016年第2期5卷 37-42页

作者： Zijun Liu Shiyong Yang Pengcheng Xi Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing China

The present report describes a case of hemobilia caused by hepatic pseudoaneurysm. A 63-year-old woman was admitted with abdominal pain and mild jaundice. She was diagnosed as choledocholithiasis and hypersplenism and underwent choledocolithotomy and splenectomy. 9th day post operation, massive fresh blood suddenly flew out from T tube and she underwent emergency abdominal exploration but there were no obvious bleeding sites in the abdominal cavity and no bleeding sites in the biliary tree by choledochoscope. 7th day after the second operation, fresh blood suddenly flew out from T tube again and angiography showed two small peudoaneurysms at the second branch of right hepatic artery which might result in hemobilia. The hemobilia was treated successfully with coil embolisation of peudoaneurysms and she recovers fully.

关键词： Hemobilia Hepatic Pseudoaneurysm choledochostomy

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Roux-en-Y choledochojejunostomy using novel magnetic compressive anastomats in canine model of obstructive jaundice

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Hepatobiliary & Pancreatic Diseases International 2012年第1期11卷 81-88页

作者： Chao Fan,Xiao-Peng Yan,Shi-Qi Liu,Chun-Bao Wang,Jian-Hui Li,Liang Yu,Zheng Wu and Yi Lv Department of Hepatobiliary Surgery and Department of Pathology,First Affiliated Hospital,School of Medicine,Xi’an Jiaotong University,Xi’an 710061,China Department of Surgical Oncology,Third Affiliated Hospital,School of Medicine,Xi’an Jiaotong University,Xi’an 710068,China Department of Hepatobiliary Surgery School of Medicine Xi'an Jiaotong University Xi'an 710061 Xi'an China Department of Pathology First Affliated Hospital School of Medicine Xi'an Jiaotong University Xi'an 710061 Xi'an China Department of Surgical Oncology Third Affliated Hospital School of Medicine Xi'an Jiaotong University (Shaanxi Provincial People's Hospital) Xi'an 710068 Xi'an China

BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of ***:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y *** compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up ***:The time spent on constructing the anastomosis for the study group was significantly *** no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control *** was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study ***:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.

关键词： anastomosis,Roux-en-Y choledochostomy jaundice,obstructive magnetic compressive anastomats

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Endoscopic ultrasound guided interventional procedures

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 628-642页

作者： Vishal Sharma Surinder S Rana Deepak K Bhasin Department of Gastroenterology Postgraduate Institute of Medical Education and Research

Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunityto target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.

关键词： Endosonography Pancreatic pseudocyst Celiac plexus choledochostomy Cholecystostomy Photochemotherapy Abdominal abscess Common bileduct Pancreatic duct Endoscopic ultrasound-guidedfine needle aspiration

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